Dr Ewa’s Cases Flashcards
Mx of NEC
Complete bowel rest, fluids and ABx
Surgery - Ladds procedure
Intussusception Sx
Prodromal coryzal symptoms causing enlarged lymph nodes
Abdo pain
Red currant jelly stool
Baby crying in episodes due to colicky pain
Mx of abdo pain
Fluids, analgesia
Rectal air enema / contrast enema
Surgery detangling or resection of bowel
Causes of abdo pain in kids
NEC Pyloric stenosis Constipation Appendicitis Intussusception DKA HSP Mesenteric addenitis Gastroenteritis Coeliac
Abdo pain after eating in slim teenager ? Mx?
H Pylori - stool sample
What is seen on CXR of duodenal atresia?
Double bubble sign
Sx of pyloric stenosis ?
Projectile Vomiting & crying
Sx of cows milk protein allergy mild and severe
Mild to mod - colick, diarrhoea, food aversion, constipation, blood in stool, erythema
Severe - failure to thrive, atopic dermatitis
What type of reaction is anaphylaxis
IgE mediated
Mx of cows milk protein allergy
Avoid all milk products - inc cheese yoghurt etc (mother and baby if breastfeeding)
Tell mother to take vitamin D while breastfeeding
Try above for 6 weeks then rechallenge
Try hydrolysed formula is formula fed baby
Causes of breathing difficulty
Asthma
Croup
Bronchiolitis
Anaphylaxis
Description of asthma Sx
Interval symptoms
Signs of difficulty breathing
Can’t speak full sentences RR high Intercostal and sub coastal recessions Nasal flaring Tracheal tug Head bobbing Shunting
What is a bad sign in asthma?
Rising and normalising PCO2
Can’t speak full sentences
Peak flow < 33%
PC of bronchiolitis
Fever, cough, breathing difficulties, inspiratory creps (crunchy noise) plus wheeze. High RR
What causes bronchiolitis
RSV
Mx of bronchiolitis
Supportive - o2 and NG feeding if needed
CPAP if needed
What can be given to prevent bronchiolitis in at risk babies? Eg prem
Panulizimab AB given every month
Features of croup
Coryzal Sx
Barking cough
Stridor
What causes croup
Parainfluenza
Mx of croup
All get dexamethasone
Can give nebulised adrenaline if needed but they can get worse v quickly after
What score is used to categorise croup?
Westley score
Features of epiglottitis
Stridor Drooling Leaning at end of bed High fever Look toxic
Cause of epiglottis
HiB
Mx of epiglottitis
ABx IV
Senior anaesthetist help
Intubation if needed
Sx of pneumonia
Fever Productive cough Chest pain Coryzal symptoms Tachypnoea and tachycardia
Mx of pneumonia
CAP - amoxicillin, antipyretics
Complicated - IV ABx, plus fluids
What causes whooping cough
Bordatella pertussus
Mx of whooping cough and why
Erythromycin - makes them less infectious to others
Complication of whooping cough
Apnoea
Sx of meckels
Blood in stool
Pain in abdo
Sx of periorbital cellulitis
Swollen eyes
Sometimes can’t open eye
Reduced eye movements and vision
Mx of periorbital cellulitis
ABx
Nasal wash and sprays
Decongestants
MRI to check it’s not spread backwards
What is orbital cellulitis ?
ENT emergency
Sx of otitis media
Pain
Fever
Bulging red ear drum
Mx of otitis media
Usually nothing as it was resolve
ABx
When does foreign body in ear need to be removed immediately?
If it’s organic, as it will swell
Features that make febrile seizure into complex
More than 15 mins
May be repetitive
May have Todd’s paresis - paralysis of one side in seizure
Fever over 38
Does simple febrile convulsions risk you for epilepsy?
No - complex do
What is petite mal seizure?
Absence seizures - kid will zone out then come back
What are infantile spasms?
Repetitive movements in between crying
Common in children with HIE
EEG sign of infantile spasms
Hipps arrhythmia
Complications of infantile spasms
Regression of skills and development
Mx of infantile spasms
IV steroids and vigabatrin
What is adrenarchy?
Starting puberty early
When is delayed puberty?
13 in girls, 13.5 in boys
Causes of delayed puberty
Poor nutrition Turners Inflammatory disorders - UC/coeliac Pituitary issues Radiation
Normal growth velocity in pre pubertal child
5cm a year
How do you calculate growth velocity
Measure in 6 month periods
How is jaundice Ix and Mx in neonates?
Check SBR
Phototherapy
If bad, exchange transfusion
Big cause of prolonged jaundice in neonates
Breast milk jaundice
Important cause of jaundice in neonates to pick up
ABO mismatch - haemolysis of RBCs
Causes of unconjugated high BR
General infection eg UTI
Sickle cell / G6PD infection
What happens if you get BR in basal ganglia?
Conictrus - permanent damage causing CP
Causes of conjugated high BR
Biliary / liver problems - eg atresia
Causes of leg pain
Transient synovitis Septic arthritis SUFE Congenital hip Dyslocation Rickets Trauma Juvenille idiopathic arthritis Sickle cell
